Managing the Numbers

Collecting data is worthless without a plan: The importance of proactively managing our practice-value profiles.

By Chris Hoekstra, PT, DPT, OCS, FAAOMPT

All too often I have the following discussion with directors and practice owners with whom I consult. I ask if his/her clinic collects outcomes data. I typically get a response such as “Certainly we do—we are required to collect data for programs like Medicare’s Physician Quality Reporting System (PQRS) and all of our physical therapists use it with their patients.” However, as I dig deeper, the word “use” in this statement typically means data is collected at the initial evaluation and frequently at a discharge visit. Occasionally, clinics will have a process to review the aggregate outcomes and use them in such things as employee performance reviews, education planning, and potentially marketing.

It is very rare that a clinic has a cohesive system to learn from the data, apply quality improvement initiatives, and measure the effect of using the standardized data. Even rarer are those owners who combine outcomes and operational data to study the interaction between the data elements. I often hear that owners feel overwhelmed by the sheer volume of data, and they simply do not know where to start, so they either never do, or they do so halfheartedly, lacking formal followthrough. Because of this reality, clinics fail to reap the organizational benefits of collecting outcomes data.

Clinics are increasing their collection of outcomes data whether it be due to professional pressure, payer demands, or government policy. However, even those who collect data, for the most part, feel either paralyzed as to what to do with these mountains of data or fail to connect and refine data in a meaningful way that will render it useful to their practice. This is not simply my impression; others echo my experiences. Even in professions outside of health care, managers often feel satisfied by simply collecting data and rarely disseminate data or use that data to make meaningful daily business decisions.¹

In the study of information science it is understood that data makes up only the first step in a developmental process that leads to true wisdom. Data in isolation lacks context and as such is fairly useless. Information is data combined with context (such as, “80 percent of my patients with condition X respond to intervention A”). When a therapist recalls this piece of information, it becomes knowledge. Finally, once the therapist understands when to apply this knowledge to a patient scenario then they possess wisdom. Unfortunately, many clinics are content with possessing disjointed pieces of data that do not necessarily help a therapist take wise action.2 Business intelligence is the transformation from data to wisdom and requires a structure and process to manage.

Helping therapists make wise decisions sounds great, but the benefits of collecting outcomes data is only the beginning. Studies show that higher quality care is almost always more cost effective and delivered more efficiently than lower quality care.³ Payers have started using clinical quality metrics in contracting agreements in health care (pay for performance, PROMETHIUS, and quality standard bonuses, to name a few). These types of contracts, however, are still fairly rare in the physical therapy world. Further, much of physical therapy is commoditized. Payers often see all physical therapists as the same, and as such see no reason to selectively contract with only “quality” providers. Rather, they often seek convenience in providers, and thus hospital contract reimbursement rates still outpace outpatient contracts.

Insurance providers have refined their use of vast quantities of data to make payment and contracting decisions. This has resulted in payers creating value profiles of every provider by exploring such data elements as: billing code preference, units per visit, number of visits per episode, cost per episode, and cost per unit. Note that these “value profiles” rarely contain measures of clinical quality. Certainly some are beginning to require standardized clinical outcome measures, but these payers are still the minority.

As providers, we must work to create a clinical quality profile that is objective and externally comparable. We must also actively manage our value profiles. It is this judicial management of the value and quality of the care we provide that will make us attractive partners with the payer community in combating the ever rising cost of health care. We can choose to bury our heads in the sand and pretend there is not a problem, or we can choose to actively work to find a solution on our terms. Failing to do the latter will all but assure a solution will be thrust upon us by the payer community and the focus of this solution will be on maintaining their financial solvency and not that of the provider.

Here is my challenge to my profession: Collect data related to the value of the care you provide (cost, utilization, and duration) and data related to clinical quality (a standardized outcomes measurement tool and/or process measures). Use these two data categories to develop a financial and outcomes value profile of your practices. Value is simply defined as the deliverable (episode of care or functional improvement as example) divided by the cost of that deliverable (Total cost of the episode or number of visits to achieve the functional change). Compare your value profile to that of your competitors, your coworkers, and national benchmarks. If your value profiles seem low, look for a simple project for improvement. After implementing your solution, measure the impact on your value metric and repeat the cycle.

Alternate payment structures are coming (in fact they are already appearing). Those providers with the highest value of care will be in a position to thrive due to the efficiencies that come with higher quality. We have a chance to manage our image. Like it or not our data is used to create our image. We have a choice to manage our images proactively or have our images managed for us retroactively. I choose to be proactive. 

References

1. Shah S, Horne A, Capellá J. Good data won’t guarantee good decisions. Harvard Business Review. 2012;90(4):23-25.

2. Wilkinson SG, Chevan J, Vreeman D. Establishing the centrality of health informatics in physical therapist education: if not now, when? Journal of Physical Therapy Education. 2010;24(3):10-15.

3. James BC, Savitz LA. How Intermountain Trimmed Health Care Costs Through Robust Quality Improvement Efforts. Health Affairs. 2011.

Chris Hoekstra, PT, DPT, OCS, FAAOMPT, is Director of Knowledge Management for Therapeutic Associates Inc. and contributor to the CareConnections outcomes improvement system. He can be reached at chrish@taiweb.com.